Author Archives: Laura Mutsko

E.R., Urgent Care Center or Other Choices.

Imagine. Your doctor’s office is closed for the weekend and you are hit with a sudden illness or a painful injury. The conventional choice has been to head for the hospital emergency room and plan on a long wait for treatment.

But, today, there is a shift away from using hospital emergency rooms for non-life threatening emergencies. Hospital costs are skyrocketing and insurers are passing a bigger portion of these costs on to the patients.

There are a growing number of good alternatives to the ER for those times when you need immediate attention, including:

Urgent Care Centers: Most urgent care are equipped to handle a wide array of non-life threatening health needs, including fevers, coughs, sprains and stitches. Some give you the option of checking in online so you can avoid long delays in crowded waiting rooms. Most urgent care clinics offer extended hours and are open seven days a week, including holidays.

Video visits with a physician: You can skip the waiting room completely by doing a video visit. Video visits provide access to board-certified doctors 24 hours a day, 7 days a week, all from the comfort of your home, office or anywhere you have an internet connection. Video visits are most often used for common complaints, such as upper respiratory infections, allergies, flu symptoms and coughs. The physician you chat with online is able to assess your condition and send prescriptions to your pharmacy, with some insurance plans covering 100% of the cost.

24/7 nurse line:  Many health insurance plans now have a 24/7 nurse line that you can call for help determining the severity of your symptoms and advice on where to go for care.

In non-emergency situations, it is best to call your doctor’s office first. They may want to see you or suggest their preferred alternatives to the emergency room.  Your insurance provider can also help you find a conveniently located, licensed and accredited care setting and determine whether your plan covers the alternative facility’s services.

I want to stress that you should always call 911 or go to the nearest emergency room in any life threatening situation including:

  • Chest pains, shortness of breath and signs of heart attacks
  • Signs of stroke
  • Poisoning
  • Severe cuts or limb threatening injuries
  • Suicidal or homicidal feelings

 

What is meant by ‘advance care planning’ and ‘advance directives?’

Advance care planning is the process of making decisions about the kind of care you would want to receive if you were unable to speak for yourself.  It is your wishes based on your personal values, preferences and thoughtful consideration of those closest to you.

Your wishes are then put into written legal documents called advance directives. It is up to you to share these documents with your family, your medical team and those who will be entrusted to carry out your directives.

In most cases, advance directives include the following types of documents:

  • A health care proxy,which may also be called a “Health Care or Medical Power of Attorney” or a “Durable Power of Attorney for Health Care.” This document names a specific person who will make the health care decisions for you if you are unable to make them yourself. A physician must conclude that the person is unable to make their own decisions and a second doctor must agree before the medical power of attorney goes into effect.
  • A living will.Living wills give directions about the kind of health care you want when you are not able to make a decision for yourself. Living wills state which medical treatments you would accept or refuse if your life was threatened and you were not able to express these wishes.
  • After-death wishes.These may include decisions such as organ and tissue donation.

Advanced care planning is important for people of all ages because anything can happen to anyone at any time and having a plan in place will help ensure that your healthcare wishes are known and honored in any situation. In fact, today most hospitals will ask if you have advance directives any time you are admitted to the hospital.

If you have Medicare, Part B covers voluntary Advance Care Planning as part of the Medicare Yearly Wellness Visit. You can talk about an advance directive with your health care professional, and he or she can help you fill out the forms.You can also download advance directive forms online or contact your local office on aging, your state health department or an attorney to learn more about advance directives.

What if I don’t enroll in Medicare

Delaying your enrollment in Medicare can have a lasting impact on your future health-care costs. Before you put off enrolling, be aware of the consequences.

Let’s begin with Medicare Part A. Part A is premium-free if you or your spouse worked and paid taxes for ten years or more. If you are not eligible for premium-free Part A and you delay enrolling, you will be assessed a 10% penalty. You will be charged the penalty for twice the number of years you could have had Part A, but didn’t sign up.

Not enrolling in Medicare Part B when you first become eligible will result in a penalty of 10% of the Part B premium for every 12 months you put off signing up. In most case, you will pay the penalty as long as you have Part B coverage.

There is an exception. You are not required to take Part B if you or your spouse is still working and you have coverage as a result of that employment. Once this qualifying insurance ends, you and your spouse would be able to enroll without penalties.

The late enrollment penalty for Medicare Part D depends on how long you go without Part D or other creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the ‘national base beneficiary premium’ ($35.63 in 2017; $35.02 in 2018) times the number of full, uncovered months you did not have Part D or creditable coverage. You will pay this penalty for as long as you are enrolled in a Medicare Part D plan.

It is important to understand the period when you first become eligible for Medicare so you can avoid these penalties. If you qualify for Medicare by age, it starts three months before you turn 65 and lasts for a total of seven months.

Does Medicare Open Enrollment apply to Medicare Supplements?

The Open Enrollment Period does not apply to Medicare Supplements. You are permitted to purchase this type of insurance or make changes to your Medicare Supplement at any time throughout the year.

To be clear, a Medicare Supplement, sometimes referred to as Medigap Insurance, is not the same as a Medicare Advantage plan. Advantage plans are plans that provide Medicare benefits while a Medigap policy only supplements your Original Medicare benefits. It helps pay some of the health care costs not covered by Original Medicare such as copayments, coinsurance and deductibles. Medicare Supplements generally do not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

You will pay a separate premium in addition to your Medicare premiums and you will also need to purchase a separate Prescription Part D plan as this coverage is not usually included with these plans.

The best time to buy a Supplement policy is during your 6-month Medicare Supplement open enrollment period. During that time you can buy any policy sold in your state, even if you have health problems. This period automatically starts the month you turn 65 and are enrolled in Medicare Part B (Medical Insurance). After this enrollment period, if you are able to buy one, it may cost more.

You cannot have a Medicare Advantage Plan and a Medicare Supplement. In fact, it is  illegal for anyone to sell you a Medicare Supplement policy unless you’re switching back to Original Medicare.

If you are interested in learning more about Medicare Supplements, please contact me after January 1 when information on new rates should be available.

 

Can my child get Marketplace Health Insurance if it’s cheaper?

I was recently asked this question . . . 

If a child under age 26 is able to get coverage under a parent’s policy, can they get a lower cost plan with Marketplace insurance based on income if they apply themselves?

Answer:  It depends on whether the child is a dependent in the parent’s tax household.

If the under-26 child is claimed as a dependent in the parent’s tax household – and if they have access to a parent’s job-based coverage – they are not eligible for lower costs on a Marketplace plan. This is because they have access to job-based coverage.

If the child files taxes themselves, they may be eligible for lower costs on a Marketplace plan based on their income. This is true even if they have access to a parent’s job-based coverage.

But if the child is enrolled in a parent’s job-based coverage, they are not eligible for lower costs on a Marketplace plan.

My son is turning 26. What are his health insurance options?

Coverage for adult children ends on a child’s 26th birthday when they are required to secure their own health insurance. 

Regardless of whether their birthday occurs during Open Enrollment* or not, they will qualify for a Special Enrollment Period that allows them to sign up for a health plan outside of the Open Enrollment.The Special Enrollment Period will end 60 days after their birthday.

If they enroll before their 26th birthday, coverage can start as soon the first day of the month they lose coverage. If they enroll during the 60 days after their birthday, coverage will start the first day of the month after they pick a plan.

If they don’t enroll in health coverage within 60 days of their birthday, they will not have to wait to get coverage until the next Open Enrollment period and may have to pay the fee for being uninsured. For 2015, the fee is 2% of your income or $325 per adult, and $162.50 per child, whichever is more.
 
If they go without coverage for less than 3 months of the calendar year, they don’t have to pay the fee.


* Open Enrollment is going on now through February 15, 2015

Avoid these classic Medicare scams.

Medicare Open Enrollment always presents an opportunity for unscrupulous people to come out of the woodwork with financial scams designed to separate you from your hard earned money. Here are a few tips to help you avoid getting scammed:

– Never pay upfront fees. If someone asks for money to help you shop for insurance, it’s a sure sign they’re not legitimate.

–   Be wary of anyone calling you, claiming to be a Medicare representative or a representative of any other government agency. Official government agencies typically communicate by mail. If you’re concerned, ask the caller to send the information to you in writing through the mail.

– Do not fall for phone calls where someone pretends to be a representative from the government selling insurance or signing you up for Medicare. The government will not call you to sell you health insurance.

–  Do not provide personal information including your Social Security or banking info to anyone you do not know and trust. Your Medicare card has your social security number on it too, needs to be safeguarded. If you give out this information by mistake, immediately inform your banks and credit card providers.

–  If you are suspicious of a caller, simply hang up the phone.  Don’t count on caller ID to prove who the caller is.The phone number and/or organization name on your caller ID can be faked to look like a legitimate organization.

– Never give your medical history or specific treatments you have received, to anyone who asks you for it.

One of the easiest ways to protect yourself from insurance scams is to seek out a knowledgeable insurance professional who has a well-established reputation in your community. By doing so, you’ll know that your insurance agent will be around when you have questions or a claim. Mutsko Insurance Services, LLC is this kind of insurance agency. We are conveniently located in Mentor, OH and have been serving customers throughout N.E. Ohio for nine years. You can count on us to be here for you now and in the future. 

Call us at 440-255-5700 for all your health insurance needs

Here are three good reasons you should have health insurance.

Reason 1: 
1-day hospital stay                $1,910*
Physician, drugs and treatment costs not included
Reason 2:
5-day hospital stay                $9,550**
Physician, drugs and treatment costs not included
Reason 3:
Broken leg (with surgery)  $17,000-35,000***
Physician, drugs and treatment cost not included

According to the National Safety Council, one in eight people will need medical care for an accident. Will you be that one in eight?

Open enrollment for the Affordable Care Act begins November 15. If you don’t have health insurance, please make it your business to get insured this fall. Don’t risk the financial setbacks that one injury can cause.  

For a fast, no-obligation free quote, got to www.mutskoinsurance.com and click on ‘free quote.’


*statehealthfacts.org, The Henry J. Kaiser Family Foundation.
**National Hospital Discharge Survey, Centers for Disease Control and Prevention.

***Costhelper: http://health.costhelper.com/broken-leg.html. 


Will Medicare cover my dental work?

If you plan to stay with Original Medicare, your dental options will be very limited. 

Original Medicare DOES NOT pay for routine dental care, including the cost of exams, teeth cleaning, tooth extractions, x-rays and dentures. This means that you can expect to pay 100% of the costs for all these services if you want to keep your healthy smile.

Original Medicare will only cover the cost of dental procedures related to covered medical procedures. For example, Medicare will cover extractions before cancer radiation therapy or jaw reconstruction after an injury. Procedures such as these are covered because they are necessary to treat a non-dental condition. They must be treated at the same time and by the same doctor as the covered condition.

There are,  however, other affordable options for dental coverage available to you. At Mutsko Insurance Services, LLC we offer a number of Medicare Advantage Plans that include coverage for routine dental care as well as vision, hearing and prescriptions.

Coverage and costs will vary from plan to plan, and some plans may charge additional for dental coverage. There are plans that cover a percentage of your costs for cleanings, x-rays and exams while other are more comprehensive and will cover major dental services like crowns, bridges, root canals and denture, in addition to your routine care. It all depends on which plan you choose.

Before you sign up for any Medicare Advantage Plan, compare the dental coverage and costs and the find out whether your dentist is in the provider network. At Mutsko Insurance Services, we’ll do the work for you. We’ll show you your coverage options and determine whether your dentist is in the network. Our job is to help you find the plan that works best for you.

For more information on Medicare Advantage Plans, Medicare Supplements, dental, vision and other coverage options, please contact Mutsko Insurance Services, 6966 Spinach Drive in Mentor, OH or call 440-255-5700 or at lmutsko@mutskoinsurance.com to make an appointment for a Medicare review.

Is a Medicare Advantage Plan the right choice for you?

Most people understand the basics about Medicare; that Medicare is a federal health insurance program managed by the Centers for Medicare & Medicaid Services (CMS) in which the government pays your Medicare benefits when you receive them. However, many people do not have a clear understand of Medicare Advantage Plans and how they work.

Basically, Medicare Advantage Plans are a different way for you to get your Medicare benefits. Advantage Plans, are offered by private insurance companies that have been approved by Medicare. Medicare pays these companies to cover your Medicare benefits and in turn, these companies must follow rules set by Medicare.
Medicare Advantage Plans provide the same coverage as Original Medicare.* In addition, many Medicare Advantage Plans offer extra coverage like vision, hearing, dental, and health and wellness programs. Many Plans include Medicare prescription drug coverage (Part D). All Medicare Advantage Plans cover you for emergency and urgent care services as well.

You must have Medicare Part A and Part B and live in the Medicare Advantage Plan’s service area to be eligible to join.

In addition to your Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan. The total cost of the premiums, copayments and deductibles you pay under a Medicare Advantage Plan is often lower than those same total costs through Original Medicare.

A number of companies offer Plans with “zero premiums.” Although you pay no premiums to the Advantage Plan, you are still responsible for payment of your Medicare Part B premium.
Now, during Medicare’s Annual Open Enrollment Period, is the time for you to look into your Advantage Plan options. You’ll want to talk to a trusted insurance professional who can help you compare plans to determine which Plan is best for you. At Mutsko Insurance Services, we routinely provide our customers with comparisons to help them select the right Plan.

For more information on Medicare Advantage Plans, Medicare Supplements or Medicare Prescription Plans, please contact Laura Mutsko at Mutsko Insurance Services, LLC, 6966 Spinach Drive in Mentor, OH. Call 440-255-5700 or email lmutsko@mutskoinsurance.com.

*An exception is hospice care. Original Medicare covers hospice care for those in a Medicare Advantage Plan.